Laparoscopic Surgery for Ovarian Lesions: Potential Pitfalls

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Abstract
Laparoscopic surgery for ovarian lesions has the potential for an enormous positive impact on the care that we are able to provide for our patients. Technologic advances and the proliferation of new equipment have occurred at a rapid rate. However, the criteria for the safe and appropriate use of endoscopic surgery have not been developed fully or followed by all surgeons, and there is some evidence that a lack of adherence to carefully considered protocols has the potential to have an adverse impact on women with ovarian lesions. McDonough made a thoughtful presentation on the need for technology assessment in the reproductive sciences, focusing on the fact that there has been a rapid diffusion of technology without prior broad-based critical peer review and stressing the need to have scientific technology assessment. Pitkin, in his editorial on operative laparoscopy, questioned whether we are evaluating therapeutic appropriateness properly as a separate and independent issue from technical feasibility. Obviously, it would be preferable to have had more controlled prospective data on the relative merits and risks of the use of the laparoscope for resection of ovarian cysts before the widespread use of this technology. However, there are several situations in which it currently appears to have important clinical utility for the patient. In addition, it already is being used widely, and it would be inappropriate to withhold this method from our patients. However, it should be urged that careful prospective evaluation be undertaken so that both the scientific community and the public are able to have an accurate understanding of the risks, benefits, indications, and contraindications of this technology. In addition, when a surgeon is considering pelviscopic surgery for an ovarian mass, it is essential that this be done with strict adherence to carefully constructed preoperative criteria and intraoperative protocols.

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